Computerized Business Systems MedicalBillingSoftware.com Medisoft Charter Platinum Dealer

www.MedicalBillingSoftware.com 23263 Harborview Rd. Port Charlotte, FL 33980 www.MedicalCharting.com Phone: 888-691-8058 or 941-743-6666 Like us at http://www.facebook.com/medisoft.medical.billing.software Fax: 941-743-5868

McKesson Relay Health Clearinghouse SETUP OPTIONS – Choose One:

Platinum Services: $900 Premium Services: $599 Limited Services: $399 (See Reverse for Details)

ELECTRONIC CLAIMS OPTIONS – Choose One: 1 - Monthly Bundled Subscription Pricing:

$90.00 per provider

Unlimited Electronic Claims,

Electronic Remittance, and

Electronic Eligibility

Paper claims $0.55 each

2 - Monthly Unbundled Subscription Pricing:

Electronic Claims (unlimited) $50

per provider

Electronic Remittance (unlimited)

$25 per provider

Eligibility Verification (unlimited)

$25 per provider

Paper claims $0.55 each

3 - Per Transaction Pricing Electronic Claims $0.40

Eligibility Verification $0.20

Electronic Remittance $0.20

Monthly Minimum $30 per month

Paper Claims $0.55 per paper claim

Usual setup time for approval to send claims: Commercial payers – 1-2 weeks Blue Cross/Blue Shield – 2-4 weeks Medicare/Medicaid – 3-5 weeks

Hardware and Software Requirements: High-speed Internet and the Current Version of Medisoft Advanced or Network Professional

Current Version of Medisoft Basic is for sending claims only

Features: Uses McKesson’s Relay Health Clearing House

You may view a list of payers at www.collaborationcompass.com. (CMS1500 are Professional Claims.)

Integrated Insurance Eligibility (if signed up for)

Pre-claim edits

ERA processing (if available from payer)

Integrated report viewing and claim status management

Contract Term: 1 year

BillFlash STATEMENT OPTIONS

Electronic Patient Statements Delivery Service First Page: $0.71 by mail - OR - $0.25 by email

Additional Pages: $0.17

Discount available when combined with Payment Services

Statement on White Paper, Return Coupon, Envelope & Postage

$17.50/Mo Technical Support Fee Applies

No Contract Required.

Payment Services ePay: Patient Online Payment Website

View Current & Past Bills

View Payment History

OfficePay: Biller Online Payment Website.

Visa / MC / Discover: 1.37% + $0.19/trans

Amex / eCheck (ACH): $0.39/trans

EXHIBIT A - FEES AND SERVICES Please check the Services you would like and sign at the bottom before faxing or sending in with your contract.

Platinum Services $900 Includes all Premium Services listed below plus 1 year of claim rejection support.

Premium Services $599 Computerized Business System services performed for client will be limited to:

- Installation of Relay Health EDI module to one customer Computer for 1 Practice.

- Obtain one Submitter ID on behalf of customer

- Setup one Receiver for Relay Health in practice Medisoft Software

- Walk through sending claims & receiving reports

- Create Posting Codes and Walk through receiving ERA reports and posting payments

- Walk through Eligibility Verification

- Walk through Electronic Statements with Billflash

- Creation with customer of up to 10 payer agreements (EDI/ERA/Eligibility) based on practice provided information.

All customer payor agreements must be created, reviewed, signed, and approved by Relay Health within 10 weeks of

Submitter ID receipt to avoid additional fees.

- Customers converting from MedAvant: McKesson will utilize the CPID utility to convert most of the MedAvant

payor IDs to Relay Health IDs (no guarantee all payers will convert), and Computerized Business Systems will set the

payor ID for any payor agreements created by McKesson. Non MedAvant conversions: Computerized Business Systems

will set the payor ID for any payor agreements created by McKesson. Transmission of claims through the retrieval of

reports.

- Any services requested by customer which are not defined above will be billable at a rate of $125 per hour.

Limited Services $399 Computerized Business System services performed for client will be limited to:

- Installation of Relay Health EDI module to one customer Computer for 1 Practice.

- Obtain one Submitter ID on behalf of customer

- Setup one Receiver for Relay Health in a practice in Medisoft

- Walk through sending claims & receiving reports

Any services requested by customer not defined above will be billable at a rate of $125 per hour.

Setup Additional Practice $199

Electronic Statements with Billflash: $0.70 per first page, $0.17 Additional Pages. $30/Month minimum.

Additional/Add-On Services – Fees documented per line item and are cumulative:

Add-on & Setup of ERA or Eligibility $199 Add Provider to a Practice $50.00

Additional Setup or Redo Practice Setup $199 Add a New Practice in an existing account $199

Update Provider or Practice Information $50 Setup New or Additional computer $199

Copy Authorization $50

Payor Agreements (Claims/ERA/Eligibility): ___Bundle of 10 $300 ___ 1 Payer Agreement $99

DME (Durable Medical Equip) Smart Screen $150 DME with attached CMN Smart Screen $300

UB04/Institutional Smart Screen $150 (Choose One: General/Dialysis/Rehab/Rural Health, other ___________________)

Ambulance/Transportation Smart Screen $150

Hourly Service rate $125

I have read and agree to the above terms. Signature: _________________________________________